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Objective: To investigate the effect of hand action observation training, i.e., mirror neuron system (MNS) based training, on language function of aphasic patients after stroke. In addition, to reveal the tentative mechanism underlying this effect. Methods: Six aphasic patients after stroke, meeting the criteria, undergo 3 weeks' training protocol (30 min per day, 6 days per week). Among them, four patients accepted an ABA training design, i.e., they implemented Protocol A (hand action observation combined with repetition) in the first and third weeks and carried out Protocol B (static object observation combined with repetition) in the second week. Conversely, for the other two patients, BAB training design was adopted, i.e., patients took Protocol B in the first and third weeks and accepted Protocol A in the second week. Picture naming test, western aphasia battery (WAB) and Token Test were applied to evaluate the changes of language function before and after each week's training. Furthermore, two subjects (one aphasic patient and one healthy volunteer) attended a functional MRI (fMRI) experiment, by which we tried to reveal the mechanism underlying possible language function changes after training. Results: Compared with static object observation and repetition training (Protocol B), hand action observation and repetition training (Protocol A) effectively improved most aspects of the language function in all six patients, as demonstrated in the picture naming test, subtests of oral language and aphasia quotient (AQ) of WAB. In addition, the fMRI experiment showed that Protocol A induced more activations in the MNS of one patient and one healthy control when compared to Protocol B. Conclusion: The mirror neuron based therapy may facilitate the language recovery for aphasic patients and this, to some extent, provides a novel direction of rehabilitation for aphasia patients.

OBJECT Transient aphasias are often observed in the first few days after a patient has undergone resection in the language-dominant hemisphere. The aims of this prospective study were to characterize the incidence and nature of these aphasias and to determine whether there are relationships between location of the surgical site and deficits in specific language domains. METHODS One hundred ten patients undergoing resection to the language-dominant hemisphere participated in the study. Language was evaluated prior to surgery and 2–3 days and 1 month postsurgery using the Western Aphasia Battery and the Boston Naming Test. Voxel-based lesion-symptom mapping was used to identify relationships between the surgical site location assessed on MRI and deficits in fluency, information content, comprehension, repetition, and naming. RESULTS Seventy-one percent of patients were classified as aphasic based on the Western Aphasia Battery 2–3 days postsurgery, with deficits observed in each of the language domains examined. Fluency deficits were associated with resection of the precentral gyrus and adjacent inferior frontal cortex. Reduced information content of spoken output was associated with resection of the ventral precentral gyrus and posterior inferior frontal gyrus (pars opercularis). Repetition deficits were associated with resection of the posterior superior temporal gyrus. Naming deficits were associated with resection of the ventral temporal cortex, with midtemporal and posterior temporal damage more predictive of naming deficits than anterior temporal damage. By 1 month postsurgery, nearly all language deficits were resolved, and no language measure except for naming differed significantly from its presurgical level. CONCLUSIONS These findings show that transient aphasias are very common after left hemisphere resective surgery and that the precise nature of the aphasia depends on the specific location of the surgical site. The patient cohort in this study provides a unique window into the neural basis of language because resections are discrete, their locations are not limited by vascular distribution or patterns of neurodegeneration, and language can be studied prior to substantial reorganization.

Aphasia is one of the most common neurologic deficits occurring after stroke. Although the speech-language therapy is a mainstream option for poststroke aphasia, pharmacotherapy is recently being tried to modulate different neurotransmitter systems. However, the efficacy of those treatments is still controversial. We present a case of a 53-year-old female patient with Wernicke aphasia, after the old infarction in the territory of left middle cerebral artery for 8 years and the recent infarction in the right middle cerebral artery for 4 months. On the initial evaluation, the Aphasia Quotient in Korean version of the Western Aphasia Battery was 25.6 of 100. Baseline brain F-18 fluorodeoxyglucose positron emission tomographic images demonstrated a decreased cerebral metabolism in the left temporoparietal area and right temporal lobe. Donepezil hydrochloride, a reversible acetylcholinesterase inhibitor, was orally administered 5 mg/d for 6 weeks after the initial evaluation and was increased to 10 mg/d for the following 6 weeks. After the donepezil treatment, the patient showed improvement in language function, scoring 51.0 of 100 on Aphasia Quotient. A subtraction analysis of the brain F-18 fluorodeoxyglucose positron emission tomographic images after donepezil medication demonstrated increased uptake in both middle temporal gyri, extended to the occipital area and the left cerebellum. Thus, we suggest that donepezil can be an effective therapeutic choice for the treatment of Wernicke aphasia.

Early identification of patients with stroke-induced aphasia is essential because it is a significant disability affecting daily life and is linked to poor functional outcome after stroke. However, most patients with stroke are unable to undergo aphasia evaluation and detection and therefore remain undiagnosed. The purpose of this study is to develop a valid, reliable mobile aphasia screening test (MAST) for patients in remote locations.To accomplish this, we enrolled patients with (n=30) and without (n=30) stroke-induced aphasia. A MAST, which adopted the Korean version of the shortened version of the Frenchay Aphasia Screening Test (K-FAST), was designed as an iPad(®) (Apple, Cupertino, CA) application. To validate the MAST, we compared its performance with that of the Korean version of the Western Aphasia Battery (K-WAB) and conventional shortened FAST paper version (K-FAST). We analyzed interrater and internal reliability, using Cronbach's alpha coefficient, and assessed the diagnostic sensitivity, specificity, and power.There was significant correlation between K-FAST and MAST (intraclass correlation coefficient [ICC]=0.995, p0.001). MAST also had a high correlation with K-WAB (ICC=0.752, p0.001). Interrater reliability was very high (ICC=0.999, p0.001). The test had high sensitivity (90.0%) and specificity (73.3%) with an accuracy of 0.930 (95% confidence interval=0.853-1.000). The MAST is a valid and reliable tool for detecting aphasia in patients with stroke.This telescreening test may overcome the limitations of test administration and may be a convenient and cost-effective alternative to the existing aphasia screening tests for patients with stroke.

Objective: To describe language impairment in the corticobasal degeneration syndrome (CBDS) presenting as either a cognitive or motor disorder, to compare the evolution of aphasia in CBDS with primary progressive aphasia (PPA), and to examine whether the side of maximal cerebral atrophy or akinesia reflects the severity of aphasia. Methods: We divided 40 patients with CBDS according to motor or cognitive onsets and conducted detailed language assessments with the Western Aphasia Battery (WAB). We analyzed scores according to the side of atrophy and motor rigidity. Longitudinal performance over three annual assessments was compared against matched patients with PPA and Alzheimer disease. Results: Language at baseline was more impaired in cognitive than motor-onset CBDS but there was no correlation between the side of atrophy or motor impairment and the WAB. Serial assessment (n = 19) showed a similar evolution of aphasia in cognitive-onset CBDS and PPA and delayed aphasia in motor-onset CBDS. Conclusion: Aphasia is common in the corticobasal degeneration syndrome but there is little correlation with the laterality of clinical deficits. Cognitive-onset corticobasal degeneration syndrome and primary progressive aphasia are similar such that their aphasia appears identical.

Introduction For several years non invasive brain stimulation (NIBS) techniques like rTMS and tDCS were used in combination with speech and language therapy. There is evidence that both techniques are able to enhance behavioral treatment effects by inhibiting right Broca’s area and thereby facilitating reintegration of perilesional activation. However, to date, there is a lack of systematic randomized trials comparing the effectiveness of the two techniques. Question Does additive, inhibitory rTMS or tDCS over right Broca’s area for two weeks enhance behavioral treatment effects in patients with subacute poststroke aphasia? Method Protocol and participants: In a multicenter, multilingual (German, English, French) clinical trial 90 right-handed participants with subacute aphasia after ischemic stroke in the left MCA territory are randomly assigned to: rTMS-group, tDCS-group, or Sham-group. Participants receive 10 sessions of 45 min speech and language therapy after/during rTMS, tDCS or sham stimulation over two weeks. Stimulation protocol: Inhibitory (1 Hz) rTMS or cathodal tDCS over right pars triangularis (BA 44/45). Outcome measures: Primary multilingual outcome measures are the Boston Naming Test (BNT), a verbal fluency test, and the Token Test. Secondary outcome measures are the Aachen Aphasia Test (German), the Western Aphasia Battery (English) and the Montreal-Toulouse Language Assessment Battery for Aphasia (French). Outcome measures are assessed the day before and the day after the treatment period and after a 30 days follow-up time. Summary This study will be the first multilingual, multinational randomized trial comparing the additive effects of two NIBS techniques on the outcome of aphasia therapy in patients with subacute aphasia. Literature Thiel et al. (2015) Non-invasive repeated therapeutic stimulation for aphasia recovery: A multilingual, multicenter aphasia trial. J Stroke Cerebrovasc, 24 (4): 751–758. Rubi-Fessen et al. (2015) Add-on effects of rTMS on subacute aphasia therapy: Enhanced improvement of functional communication and basic linguistic skills. A randomized controlled study. Arch Phys Med Rehab, 96: 1935–1944. Thiel et al. (2013) Effects of noninvasive brain stimulation on language networks and recovery in early poststroke aphasia. Stroke, 44: 2240–2246.

Background: The study of self‐esteem after stroke may provide valuable prognostic information of the potential for functional recovery and may also inform the approach to treatment. Hitherto, research into the effect of post‐stroke aphasia on self‐esteem has received little attention. The purpose of the present study is to examine the relationship between aphasia and self‐esteem and to establish whether the severity of aphasia correlates significantly with the level of self‐esteem. Methods & Procedures: Self‐esteem was measured with the Visual Analogue Self‐Esteem Scale (VASES) and aphasia was assessed with the Western Aphasia Battery (WAB). Assessments were made as soon as practicable after the stroke onset and 3 and 6 months after the first evaluation. Outcomes & Results: Of 51 eligible patients, 40 completed the study. The mean (SD) VASES scores at baseline, 3 and 6 months post‐entry were 36.8 (7.6), 37.6 (7.2), and 38.5 (7.7), respectively. WAB scores were 71.3 (22.9) at 3 months and 72.0 (21.1) at 6 ...

Background: Normal elderly and mildly aphasic individuals may exhibit similar impairments in language comprehension and expression. Accurate differential diagnosis is essential for providing a prognosis, focusing treatment, and justifying reimbursement for services. Aims: We employed the principles of evidence‐based medicine to examine the accuracy of two general language tests (Porch Index of Communicative Ability; Western Aphasia Battery) and two functional communication tests (Communication Activities of Daily Living; American Speech‐Language‐Hearing Association's Functional Assessment of Communication Skills for Adults) for diagnosing mild aphasia, beyond individual clinical expertise. Methods & Procedures: The test performance of 10 mildly aphasic patients was compared with that of 10 non‐brain‐injured (NBI) adults. An operational definition of aphasia was applied as a reference standard for correct diagnosis. Pre‐test and post‐test diagnostic probabilities were compared, using the likelihood ratio a...

We examined the abilities of aphasic patients to make grammaticality judgments on English sentences instantiating a variety of syntactic structures. Previous studies employing this metalinguistic task have suggested that aphasic patients typically perform better on grammaticality judgment tasks than they do on sentence comprehension tasks, a finding that has informed the current view that grammatical knowledge is relatively preserved in agrammatic aphasia. However, not all syntactic structures are judged equally accurately, and several researchers have attempted to provide explanatory principles to predict which structures will pose problems to agrammatic patients. One such proposal is Grodzinsky and Finkel's (1998) claim that agrammatic aphasics are selectively impaired in their ability to process structures involving traces of maximal projections. In this study, we tested this claim by presenting patients with sentences with or without such traces, but also varying the level of difficulty of both kinds of structures, assessed with reference to the performance of age-matched and young controls. We found no evidence that agrammatic aphasics, or any other subgroup, are selectively impaired on structures involving traces: Some judgments involving traces were made quite accurately, whereas other judgments not involving traces were made very poorly. Subgroup analyses revealed that patient groups and agematched controls had remarkably similar profiles of performance across sentence types, regardless of whether the patients were grouped based on Western Aphasia Battery classification, an independent screening test for agrammatic comprehension, or lesion site. This implies that the pattern of performance across sentence types does not result from any particular component of the grammar, or any particular brain region, being selectively compromised. Lesion analysis revealed that posterior temporal areas were more reliably implicated in poor grammaticality judgment performance than anterior areas, but poor performance was also observed with some anterior lesions, suggesting that areas important for syntactic processing are distributed throughout the left peri-sylvian region.

Aim: To determine the types, severity and evolution of aphasia in unselected, acute stroke patients and evaluate potential predictors for language outcome 1 year after stroke. Methods: 270 acute stroke patients with aphasia (203 with first-ever strokes) were included consecutively and prospectively from three hospitals in Copenhagen, Denmark, and assessed with the Western Aphasia Battery. The assessment was repeated 1 year after stroke. Results: The frequencies of the different types of aphasia in acute first-ever stroke were: global 32%, Broca’s 12%, isolation 2%, transcortical motor 2%, Wernicke’s 16%, transcortical sensory 7%, conduction 5% and anomic 25%. These figures are not substantially different from what has been found in previous studies of more or less selected populations. The type of aphasia always changed to a less severe form during the first year. Nonfluent aphasia could evolve into fluent aphasia (e.g., global to Wernicke’s and Broca’s to anomic), whereas a fluent aphasia never evolved into a nonfluent aphasia. One year after stroke, the following frequencies were found: global 7%, Broca’s 13%, isolation 0%, transcortical motor 1%, Wernicke’s 5%, transcortical sensory 0%, conduction 6% and anomic 29%. The distribution of aphasia types in acute and chronic aphasia is, thus, quite different. The outcome for language function was predicted by initial severity of the aphasia and by the initial stroke severity (assessed by the Scandinavian Stroke Scale), but not by age, sex or type of aphasia. Thus, a scoring of general stroke severity helps to improve the accuracy of the prognosis for the language function. One year after stroke, fluent aphasics were older than nonfluent aphasics, whereas such a difference was not found in the acute phase.

Normal elderly and mildly aphasic individuals may exhibit similar impairments in comprehension and expression. The discriminative validity between normal and aphasic performance on most standardized measures of aphasia has not been reported. The authors compared the performance of 18 aphasic and 18 normal adults to determine the discriminative validity of 2 general language measures—the Porch Index of Communicative Ability (B. E. Porch, 1967) and the Western Aphasia Battery (A. Kertesz, 1982)—and 2 functional communication measures—the Communication Activities of Daily Living-Second Edition (A. L. Holland, C. Frattali, & D. Fromm, 1999) and the American Speech-Language-Hearing Association’s Functional Assessment of Communication Skills for Adults (C. Frattali, C. K. Thompson, A. L. Holland, C. B. Wohl, & M. K. Ferketic, 1995). All between-groups comparisons of summary scores for each measure showed significant mean differences. Expressive language ability and efficiency of performance best differentiated between the aphasic and normal groups. However, group performance ranges overlapped by at least 10% on each measure. To enhance the differential diagnosis of aphasia, supplementing formal test results with additional subjective and objective evidence is recommended.

Background: Bilingualism is an area of linguistics that has been investigated in aphasic patients. However, bilingualism and Alzheimer's disease (AD) have not been fully investigated despite the fact that language impairment is a frequent symptom of AD. Brazil has the greatest number of Japanese immigrants and, consequently, there are many bilingual people who are fluent in both Japanese and Portuguese in Brazil. Methods: Using the results from a previous epidemiological survey, we found four AD patients who were fluent in both Japanese and Portuguese before developing AD, and performed the following evaluations in both languages: confrontation naming, oral reading ability, vocabulary comprehension (matching words and drawings), written lexical decision and the Western Aphasia Battery (WAB). Results: All patients demonstrated impaired naming ability in both languages. Oral reading ability was most impaired in the case of Kanji, followed by irregular words in Portuguese. The patients could recognize and pronounce Kana perfectly, and regular Portuguese words almost perfectly. In the severest case, the patient showed disturbed lexical comprehension and lexical decision, especially when faced with Kanji. The WAB classified three patients as having anomic aphasia in both languages, whereas in the severest case the patient was classified as having anomic aphasia in Portuguese and Wernicke aphasia in Japanese. Conclusion: These results may reflect different patterns in language deterioration as AD progresses, with Kanji being more readily affected by the disease than Kana and Portuguese. This is the first study to focus on Japanese–Portuguese bilingualism in AD patients.

Background: There is a need for discourse research with African Americans who have aphasia, highlighted by ethnic group differences in stroke prevalence, and potential ethnic group differences in dialect. Identification of ethnic dialect is critical to differentiate communication changes associated with pathology from normal communicative differences associated with ethnicity. Also, preliminary research on adults with aphasia indicates an uncertain relationship between discourse performance and standardised test performance. Aims: This study was designed to assess: (1) the relationship between performance on a standardised language measure and discourse performance, and (2) the use of ethnic dialect and discourse features, in the narrative productions of African-American adults with moderate aphasia on a variety of discourse tasks. Methods & Procedures: We investigated the discourse of 12 African Americans with scores in the moderate severity range on the Western Aphasia Battery, Aphasia Quotient (WAB-AQ)...

Background: Important to the assessment of aphasia are analyses of discourse production and, in particular, lexical diversity analyses of verbal production of adults with aphasia. Previous researchers have used type-token ratio (TTR) to measure conversational vocabulary in adults with aphasia; however, this measure is known to be sensitive to sample size, requiring that only samples of equivalent length be compared. The number of different words (NDW) is another measure of lexical diversity, but it also requires input samples of equivalent length. An alternative to these measures, D, has been developed (Malvern & Richards, 1997) to address this problem. D allows for comparisons across samples of varying lengths. Aims: The first objective of the current study was to examine the relationships among three measures of productive vocabulary in discourse for adults with aphasia: TTR, NDW, and D. The second objective was to use these measures to determine in what ways, and to what degree, they each can differentiate fluent and nonfluent aphasia. Methods & Procedures: Eighteen adults with aphasia participated in this study (nine with nonfluent aphasia; nine with fluent aphasia). Participants completed the Western Aphasia Battery (WAB) and produced language samples consisting of conversation and picture description. Samples were then subjected to the three lexical diversity analyses. Outcomes & Results: Results indicated that, although the measures generally correlated with each other, adults with fluent aphasia evidenced significantly higher D and NDW values than those with nonfluent aphasia when whole samples were subjected to analyses. Once samples were truncated to 100- and 200-word samples, groups differed significantly for all three measures. Conclusions: These findings add further support to the notion that because TTR and, although to a lesser extent, NDW are sensitive to sample size, length differences across samples tend to confound results. As an alternative to these measures, the use of D for the measurement of conversational vocabulary of adults with aphasia enables the analysis of entire language samples, so that discarding language sample data is not necessary. In the present study, D values differed for fluent and nonfluent aphasia samples.

Introduction: The purpose of this study was to complete a sociolinguistic adaptation and validation of the Western Aphasia Battery-Revised (WAB-R) (Kertesz and Raven, 2007), an English aphasia assessment into the Bangla language. Two hundred and fifty million people speak Bangla/Bengali in eastern parts of India and Bangladesh. Methods: This study had two steps: first, three professional translators performed the translation and back-translation processes on the WAB-R. Second, to validate the adaptation, 27 neurologically normal individuals and 36 patients with a history of cerebrovascular accident participated in this study. Results: Three types of adaptation processes, i.e., introduction of new words or phrases, direct translation, and direct translation replacing concepts were involved. As per different adaptation processes, Record form part 1 (derives aphasia quotient [AQ]) achieved 25% of sociocultural and linguistic changes whereas Record form part 2 (derives cortical quotient and language quotient) achieved 57% of sociocultural and linguistic changes. The items of Bedside record form (shorter version of the test) were taken from Record form part 1 and part 2. Normal controls completed the test with scores of 100% on most of the sub-tests while the patients' performance was significantly lower. Eighty percentage of the patients had aphasia, based on their test scores, and investigators could categorize the patients by aphasia type based on the AQ and bedside aphasia score. There is a high correlation between the subtest scores of Record form part 1 and Bedside record form. Conclusion: Some changes were needed to adapt the WAB-R for Bangla speakers. Preliminary validation study demonstrated that the Bangla WAB-R could differentiate the normal population from the patients with aphasia by their language performance. Investigators will attempt to standardize the test in the next phase of the study.

Context: With advances in neuroimaging, traditional views regarding the clinicoanatomic correlation in stroke patients with aphasia are being challenged and it has been observed that lesions at a given cortical or subcortical site may manifest with different aphasia profiles. Aims: To study as to whether there is a strict clinicoanatomical correlation between the type of aphasia and lesion site in patients with first ever stroke. Settings and Design: Observational study, based in a tertiary care center. Materials and Methods: Stroke patient′s ≥18 years of age were screened and those with first ever stroke and aphasia were subjected to a detailed stroke workup and language assessment using the Hindi version of Western Aphasia Battery (WAB). Statistical analysis was done with χ2 test with Yates correction and Kruskal-Wallis test. The level of significance was set at P < 0.05. Results: Overall aphasia was detected in 27.9% of the 260 screened cases with stroke. Amongst 60 cases with first ever stroke and aphasia, the aphasia type was: Global (33.33%), Broca′s (28.3%), transcortical motor (13.33%), transcortical sensory (10%), Wernicke′s (8.33%), anomic (5%), and conduction (1.67%) aphasia. A definite correlation between the lesion site and the type of aphasia as per the traditional classification was observed in 35% cases only. Conclusions: No absolute correlation exists between the lesion site and the type of clinical aphasia syndrome in majority of the patients with cortical and subcortical stroke.

To investigate the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) and speech and language therapy (SLT) on the improvement of performance on the Korean-version of the Western Aphasia Battery (K-WAB) in post-stroke non-fluent aphasic patients.Twenty post-stroke, non-fluent aphasic patients were enrolled and assigned to one of two groups: a case group (n = 10) or a control group (n = 10). Participants were recruited from the inpatient clinic of the Physical and Rehabilitation Medicine Department of Bundang Jesaeng General Hospital from March 2011 to January 2012. The case group received rTMS and SLT and the control group received SLT; both groups received these therapies for four weeks. Language functioning was evaluated using K-WAB before and after treatment.There were no significant differences between the groups' baseline characteristics and initial values (p0.05). After four weeks of therapy, there were significant improvements in repetition and naming in the case group (p0.05). However, there was no significant improvement in the control group (p0.05).rTMS combined with SLT can be an effective therapeutic method for treating aphasia in post-stroke non-fluent aphasic patients, although additional controlled and more systemic studies should be conducted.

Despite the prevalent and natural use of metaphor in everyday language, the neural basis of this powerful communication device remains poorly understood. Early studies of brain-injured patients suggested the right hemisphere plays a critical role in metaphor comprehension, but more recent patient and neuroimaging studies do not consistently support this hypothesis. One explanation for this discrepancy is the challenge in designing optimal tasks for brain-injured populations. As traditional aphasia assessments do not assess figurative language comprehension, we designed a new metaphor comprehension task to consider whether impaired metaphor processing is missed by standard clinical assessments. Stimuli consisted of 60 pairs of moderately familiar metaphors and closely matched literal sentences. Sentences were presented visually in a randomized order, followed by four adjective-noun answer choices (target + three foil types). Participants were instructed to select the phrase that best matched the meaning of the sentence. We report the performance of three focal lesion patients and a group of 12 healthy, older controls. Controls performed near ceiling in both conditions, with slightly more accurate performance on literal than metaphoric sentences. While the Western Aphasia Battery (Kertesz, 1982) and the objects and actions naming battery (Druks and Masterson, 2000) indicated minimal to no language difficulty, our metaphor comprehension task indicated three different profiles of metaphor comprehension impairment in the patients’ performance. Single case statistics revealed comparable impairment on metaphoric and literal sentences, disproportionately greater impairment on metaphors than literal sentences, and selective impairment on metaphors. We conclude our task reveals that patients can have selective metaphor comprehension deficits. These deficits are not captured by traditional neuropsychological language assessments, suggesting overlooked communication difficulties.

Conduction aphasia, most often caused by damage to the inferior parietal lobe and arcuate fasciculus, is usually characterized by mildly dysfluent speech with frequent phonemic paraphasic errors, impaired repetition, and impaired word finding and naming, but with relatively spared comprehension. We report an 86-year-old right-handed man with conduction aphasia caused by an infarction that damaged his right temporoparietal region. On testing with the Western Aphasia Battery, however, he named objects almost perfectly. To test his naming ability further, we showed him half the items in the Boston Naming Test; we described or defined the other half of the items, but did not show them to the patient. He performed excellently when naming the objects that he could see, but he had difficulty naming the objects that were only described or defined. These observations suggest that visual word naming may be mediated by a network that is somewhat independent of the networks that mediate spontaneous word finding and word finding based on verbal descriptions or definitions.

We report an outcome study of persons with aphasia participating in community-based treatment programmes. Patients (n = 50) were assessed before and after treatment using: (i) a standardised test of impairment, the Western Aphasia Battery, administered by treating clinicians; and (ii) a standardised assessment of disability (functional communication), the Communicative Effectiveness Index, rated by family members. Pretreatment and post-treatment means are calculated and compared, with matched t -tests utilised to probe statistical significance of improvements after treatment. We then calculate impairment- and functional-level means by aphasia diagnostic categories, assigning rank orders and calculating Spearman rank-order correlations. Data analysis shows that, before treatment, patients spanned a wide range of times after onset, aphasia diagnostic types, and severity levels at start of care. Following treatment, means of the 50 patients improved significantly on every measure administered at both the imp...

We compared performance on language impairment, functional communication, and discourse measures between 33 African-American aphasic patients and 30 African-American normal subjects. The aphasic group performed significantly lower than the normal group on the Western Aphasia Battery Aphasia and Cortical Quotients, Token Test, and ASHA Functional Assessment of Communication Skills for Adults. Moreover, the aphasic group performed significantly lower than the normal group in their quality of language on a discourse task that required telling a frightening experience. Significant relationships between performance on the measures were confined to those that index language impairment. Use of a normal ethnic cohort for comparison with African-American aphasic performance may control for potential ethnic bias in the measures. In addition, use of a discourse task permits observation of grammatical and stylistic features in African-American English that may not be captured or are ignored by traditional language im...

The study investigated the psychometric characteristics of a Danish adaptation and translation of the Communicative Effectiveness Index (CETI). A total of 68 patients with left hemisphere strokes, who had aphasia on admission, were assessed with the CETI at least 1 year after stroke, when 53 of them were still aphasic. Language functions were also assessed with the Western Aphasia Battery (WAB) in 65 and the Porch Index of Communicative Abilities (PICA) in 33 patients. After about 4 months 19 patients were retested in order to compare sensitivity to chance in language function. Activities of daily living were assessed with the Barthel Index (BI) and the Frenchay Activities Index (FAI), and depression was assessed with an illustrated, seven-item visual-analogue scale in a subset of the patients. Reliability measured as internal consistency was satisfactory and on the level of the original standardisation. The 3½ month test–retest reliability was lower than in the WAB and the PICA when measured by correlati...

There is a paucity of performance information for African American adults with aphasia on appraisal tasks, especially in comparison with performance by neurologically normal African American adults. We administered language impairment, functional communication, and discourse measures to neurologically normal African American adults and African American adults with aphasia. The neurologically normal group performed significantly better on the language impairment measure (Western Aphasia Battery), the functional communication measure (ASHA Functional Assessment of Communication Skills for Adults), providing the lesson in a fable discourse task, and spontaneous interpretation of proverbs. No significant differences between groups were observed on a picture description fable task or in performance on a multiple-choice proverb task. Few significant relationships were observed among measures in the neurologically normal group; however, the group with aphasia displayed a variety of significant relationships in their performance on the language impairment, functional communication, fable lesson, and interpretation of proverbs tasks. The results imply that fable and proverb discourse tasks may be valuable supplemental measures for characterizing communicative competence in African American adults who have aphasia.

The syndrome of transcortical sensory aphasia (TCSA) is usually associated with extraperisylvian lesions of the left hemisphere that involve either posterior cortical regions (temporal-occipital cortex and inferior parietal cortex) or subcortical structures (thalamus). In exceptional cases, TCSA occurs in association with anterior perisylvian lesions involving the left Broca's area and its adjoining regions. This unconventional brain–language relationship is intriguing, because it contradicts the tenets of traditional aphasiology. This article reviews the extant literature of TCSA cases with frontal lesions. In the second section, the author assesses new cases of TCSA with frontal lesions in a two-part study. In Study 1 the issue of whether the language profile of TCSA with frontal lesions fits well with the diagnostic criteria of TCSA was investigated by comparing the language scores of the Western Aphasia Battery (WAB) in three groups of TCSA: Group 1: eight patients with posterior hemispheric damage; G...

The aim of this study was to develop and evaluate a scripted modular intervention programme called Speaking Out. Speaking Out is administered by trained volunteers in the home and focuses on the everyday communicative activities of aphasic stroke patients. The experimental design used repeated measures to examine the effect of counterbalanced treatments across individual subjects and across two matched groups. One group improved significantly on the Western Aphasia Battery (WAB) after the Speaking Out programme but there were no significant differences on any of the functional communication measures. Some change to health status scales was however found. There was a significant difference on both the WAB and the ASHA Functional Assessment of Communication Skills (ASHA FACS) for the other group following the Speaking Out programme. They also demonstrated some positive changes on the health status scales following the programme. There were more significant differences on intragroup comparisons than intergro...

This study examines the lexical self- and other-repetition and the strategic use of repetition by two aphasic speakers (J and M) with agrammatic and severe word-finding difficulties in group discussions. Whereas the speakers aphasia profiles were rather similar, as defined by clinical testing (Western Aphasia Battery), their use of lexical repetition as a communicative strategy was significantly different. One speaker (speaker M) had more contextually supported words, especially other-repetitions. M sometimes repeated her own lexical elements and elaborated the repetitions morphologically and prosodically and expanded them syntactically. These elaborated and expanded repetitions were attempts at communicative clarity and grammatical acceptability. After encountering problems in production, speaker M used selfand other-repetition both in affective confirmations and in meaning negotiations. Speaker J, on the other hand, did not attempt to produce grammatical well-formed utterances, but relied on his interlo...

We evaluated the mismatch negativity (MMN) event-related potential (ERP) in normal and aphasic adults to tone and speech stimuli to determine aphasic patients' auditory discrimination and the relationship between MMN measures and severity of aphasia. MMNs were present in 89 % of normal subjects and 79 % of aphasic subjects to tone stimuli. MMNs were present in 100% of normal subjects and 54 % of aphasic subjects to speech stimuli. The duration of the MMN ERP to speech stimuli was significantly related to severity of aphasia on the Western Aphasia Battery, Porch Index of Communicative Ability, and the Token Test. Thus, not all aphasic people show an early, preconscious orientation response to tone and speech stimuli. However, the duration of this response, when present, to speech stimuli appears to be related to the severity of aphasia.

Diagnosis of aphasia from electroencephalogram (EEG) was investigated. EEG data of the following patients were collected; the patient of total aphasia who is difficult to understand the speech and the patient of motor aphasia (Broca aphasia) who feels pain or makes some grammatical mistakes when he speaks anything while he can understand the speech. At first, power spectrum of EEG was extracted by the fast Fourier transform (FFT). The spectrum was separated into 9 regions, corresponding to the characterized wave. The regions with 4.0 to 5.9, 6.0 to 7.9 and 8.0 to 12.9 Hz were selected as the frequency band of θ1, θ2, and α waves, respectively. Assessment of linguistic ability was carried out by Western aphasia battery (WAB). The relative power values were input into each NN model for estimation of aphasia quotient (AQ) score or score on spontaneous speech from WAB. In NN model for AQ score, 7 input valuables were selected by PIM; θ1 values of channel 2,3, and 11, θ2 values of channel 4, 9, and 13, and α value of channel 11. The average error of this model was 8.6 points, corresponding to the relative error of 10%. It was found that the model can estimate the AQ value at high accuracy. Another NN model to estimate the score on spontaneous speech was also constructed. The average error of this model with actual WAB score was 1.8 points. Predicted score of patient with motor aphasia coincided well with the actual score.

アルツハイマー病 (AD) 患者の言語障害を WAB 失語症検査の日本語版を用いて検討した。対象は NINCDS-ADRDA の Probable AD の基準を満たした連続症例のうち右利き，教育歴６年以上，80歳以下の156名と健常高齢者16名である。患者群の失語指数 (AQ) の平均値±SD は 78.9±11.1，健常高齢者群は96.0±2.9であった。患者群の AQ とすべての下位項目の成績は健常高齢者群に比べて有意に低く，MMSE，ADAS，CDR と有意に相関していた。AD 患者の言語障害には流暢な発話，比較的良好な復唱と聴理解，顕著な喚語障害と読み書き障害という特徴があった。対象患者のうち123例は健忘失語，14例は Wernicke失語，11例は超皮質性感覚失語，２例は伝導失語に分類されたが，６例は古典的な失語の範疇ではとらえられなかった。

The Western Aphasia Battery (WAB) is a standardized aphasia test which classifies aphasias into eight syndromes based on the Wernicke-Lichtheim model, commonly known as the Bostonian model. Although the syndrome approach has its limitations it is a widely used procedure in clinical aphasiology as it allows users to classify patients into discrete syndromes and to make some inference about lesion sites (Kertesz 1983). It has been shown that the Wernicke-Lichtheim framework is also applicable in classifying aphasia in Chinese, although Chinese and English linguistic structures are very different (e.g. Naeser and Chan 1980, Packard 1986, Gao and Benson 1990, Yiu 1992). The use of a common framework to classify aphasia in different languages is a useful concept, as it allows aphasia to be compared across languages. Unfortunately, aphasia classification is not always a clear-cut procedure, and use of the WAB is often queried regarding the validity of the quantitative classification. Previous reports h...

To assess the effects of solitary, right-sided supratentorial intracranial tumours on language and communication function patients were assessed preoperatively using the Western Aphasia Battery (WAB) and Boston Naming Test (BNT). The impact of resective tumour surgery was evaluated prospectively by a comparison of test scores obtained at pre- and postoperative assessments. The WAB scores in 33 patients revealed that 21% were by definition dysphasic (i.e. Aphasia Quotient < 93.8) and 35% obtained an abnormal Language Quotient. Performance was particularly variable on the written picture description and word fluency WAB subtests. Using the BNT 21% of 47 patients were anomic. The tumours were evenly distributed throughout the frontal, temporal and parietal lobes, but none were in the occipital lobe. Reassessment approximately 6 days after excisional tumour surgery showed that mean scores for the BNT, Aphasia Quotient, and the WAB spontaneous speech and comprehension subtests had improved significantly despite a significant reduction in dexamethasone therapy. This study has demonstrated that right-sided intracranial tumours produce subtle, but specific language deficits of a type more usually associated with left-sided brain dysfunction. The pathophysiological basis of these deficits is unclear, but they are not attributable to either limited education or pre-existing dyslexia. Further studies using a discriminating and comprehensive assessment of language in the right hemisphere are required.

Summary Introduction Cognitive impairment has long been recognized as a co-morbidity or sequel to refractory epilepsy. This study was conducted to evaluate the degree and selectivity of involvement of memory, language and executive functions performance among patients with temporal (TLE) versus extratemporal epilepsy (ETLE). Methods We prospectively enrolled adolescent and adult patients with medically refractory focal epilepsy, who had undergone pre-surgical evaluation. Language, memory and executive function assessment was done using Western Aphasia Battery, PGI memory scale and battery of four executive function tests (trail making test A & B, digit symbol test, Stroop Task and verbal fluency test), respectively. Results Among102 patients enrolled (TLE-59, ETLE-43), mean age of patients 23.04±8.3 years, 83 (82%) had impairment of more than one cognitive domain and 21 (21%) had all three domains involved. Severely impaired memory scores were found in 8.6% patients with MTLE-HS, 8% of the rest of the patients with TLE and 7% patients with ETLE. The differences in the mean scores were also not found statistically significant ( p =0.669). Naming impairment was the most common language abnormality, although all aphasia subscores were similar for the ETLE and TLE groups. Executive function impairment was the most common cognitive domain affected. Overall performance on executive function tests was found impaired in almost all patients of both groups without any significant inter-group difference, except on Trail-A test, which revealed better results in patients with mTLE-HS as compared to all other sub-groups. Conclusion Our study shows that impairment of memory, language and executive function is common among patients with drug refractory epilepsy. The most prevalent impairment is in executive function. There is no significant difference in the degree, prevalence or selectivity of impairment in either of the three domains, between the TLE versus ETLE groups.

s / Brain Stimulation 7 (2014) e1ee16 e7 assigned to anodal or sham tDCS(2.0mA x 20 minutes; anode over left primary motor strip 5cm lateral to vertex of skull along interaural line, cathode over right supraorbital ridge). Preliminary results from four participants (three sham, one anodal) reveal that participants receiving sham improved in their Aphasia Quotient (from Western Aphasia Battery, Kertesz, 2006), with two improving above (5.8) or near (4.4) the clinically significant benchmark of 5 points (Katz & Wertz, 1997). Participants receiving sham stimulation also improved in measures of speech motor control (diadochokinetic tests) and a verbal fluency task. The participant receiving anodal tDCS showed minimal changes between the preand post-treatment measures. A control task (symbol cancellation) revealed no changes. These findings compel further research to determine the role of tDCS andmotor therapy in speech/language outcomes with and without targeted aphasia/ apraxia therapy.

Objective: To assess chronic aphasic patients' responses to resumption of therapy using an innovative, computer-based treatment system. Design: Patients were assessed pretreatment and posttreatment using standardized assessment tools. Pretreatment and posttreatment performance score means were computed and compared, with statistical significance of the differences established using a one-tailed, matched t test. Setting: The work was conducted at (1) a Veterans Affairs medical center participating in treatment research and (2) a regional aphasia center delivering therapy services for reimbursement. Patients: Chronic aphasic patients ( n = 23) from 6 months to more than 15 years postonset were enrolled in the study. They included a wide range of types and seventies of aphasia, and all had received traditional speech-language therapy services earlier. Interventions: All patients were treated in 1-hour clinical sessions by speech-language pathologists using the designated computer-based treatment system. All but one of the patients had access to the computer-based treatment system at home for practice between clinical therapy sessions. Main Outcome Measures: The outcome measures used were (1) the Porch Index of Communicative Ability (PICA), (2) the Boston Naming Test (BNT), (3) the Western Aphasia Battery (WAB), and (4) the Boston Diagnostic Aphasia Examination (BDAE). Results: The majority of patients improved significantly in multiple modalities as assessed by these instruments. Conclusions: Specific measures of language function can be broadly, positively, and significantly influenced by computer-based language therapy in chronic aphasia.

✓ A prospective study of patients undergoing computerized tomography (CT)—guided stereotactic biopsy of nonpolar tumors in the dominant hemisphere was undertaken to determine if stereotactic biopsy caused a deterioration of language functions. Language was assessed using the Western Aphasia Battery (WAB) and the Boston Naming Test (BNT) before and after a biopsy sample was obtained. Of 16 patients studied, five (31%) were dysphasic preoperatively. After the biopsy the Aphasia Quotient (AQ), derived from the WAB, had significantly deteriorated in four (80%) of these patients, whereas in the fifth it remained relatively unchanged. One of these patients with an extensive infiltrating hemispheric oligoastrocytoma subsequently recovered normal language function after radiotherapy. In 10 of the 11 patients who had normal language function preoperatively there were no deleterious changes after biopsy in either the WAB subtest or BNT scores. In the other patient whose WAB score was normal preoperatively, there was a significant deterioration in postoperative AQ. This patient, who declined steroid therapy before and after biopsy, had a glioblastoma multiforme in Wernicke's area. A postoperative CT scan revealed no changes from what was shown on preoperative scan. This clinical study shows that CT-guided stereotactic biopsy of nonpolar tumors in the dominant hemisphere using the Brown-Roberts-Wells system and the Sedan—Nashold biopsy cannula carries a 9% risk (95% confidence intervals 0–26%) of impairing language functions if the patient is not dysphasic preoperatively. If the patient is dysphasic preoperatively, there is a very high risk of aggravating the dysphasia with stereotactic biopsy.

Objectives: Individuals with severe communication problems associated with non-fluent aphasia and concomitant apraxia of speech are often unable to perform daily communication. For these people, augmentative and alternative communication (AAC) can be challenging to participate in meaningful communication. The purpose of this study was to report the training process and functional effect of AAC in 3 cases with Broca’s aphasia. Method: Three patients (2 male and 1 female) with severe non-fluent aphasia participated in this study and all of them were recruited at the Korea University Anam Hospital. All participants presented severe Broca’s aphasia with accompanying apraxia of speech, characterized by limited verbal output. And their aphasia quotient (AQ) measured by Korean version of Western Aphasia Battery (K-WAB) were 16.2, 10.8 and 28.8, respectively. We trained them to use AAC program (MyTalkie) and observed their responses during the therapy session. Also the changes of communication effectiveness were obtained from their caregiver after training. Results: Case 1 received 8 treatment sessions, but he didn’t want to use AAC device and wanted to communicate through his speech alone. Case 2 and 3 performed 15 and 17 training session, respectively, but they had difficulty to operate AAC device due to limb apraxia and perseveration. We couldn’t observe communicative improvement by report of caregivers. However, AAC was helpful to communicate with therapist in therapy setting. Conclusion: Many people with aphasia have cognitive dysfunction and limb apraxia as well as the language impairment. For successful communication with AAC, it is important to check motivation of patient with aphasia and to evaluate cognitive function and apraxia for selection of adequate candidate for training. Also, clinicians should develop a proper strategy for training of AAC, communicative assessment tools, and specialized education program is need for the therapist.

Background and Aim The effects of very early aphasia therapy on recovery are equivocal. This article examines predictors of very early aphasia recovery through statistical modeling. Methods This study involved a secondary analysis of merged data from two randomized, single-blind trials conducted in Australian acute and subacute hospitals. Study 1 ( n = 59) compared daily therapy to usual ward care for up to 4 weeks poststroke in patients with moderate to severe aphasia. Study 2 ( n = 20) compared daily group therapy to daily individual therapy for 20 1-hour sessions over 5 weeks, in patients with mild to severe aphasia. The primary outcome measure was the Western Aphasia Battery Aphasia Quotient (AQ) at therapy completion. This analysis used regression modeling to examine the effects of age, baseline AQ and baseline modified Rankin Scale (mRS), average therapy amount, therapy intensity, and number of therapy sessions on aphasia recovery. Results Baseline AQ ( p = 0.047), average therapy amount ( p = 0.030), and baseline mRS ( p = 0.043) were significant predictors in the final regression model, which explained 30% ( p Conclusion The amount of very early aphasia therapy could significantly affect communication outcomes at 4 to 5 weeks poststroke. Further studies should include amount of therapy provided to enhance reliability of prognostic modeling in aphasia recovery.

Objective The arcuate fasciculus has been recognized as an important pathway for language processing. Brain tumors located in proximity to the fasciculus frequently cause preoperative language impairment, and in some cases, no language recovery occurs after tumor resection. No predictive value has been presented for possible postoperative language recovery after tumor resection. The aim of this study is to analyze the preoperative state of the arcuate fasciculus in the patients with brain tumor from the perspective of its usefulness as a predictive factor for postoperative recovery of language functions. Methods For 12 right-handed patients with brain tumors in the left hemisphere, preoperative arcuate fasciculi were analyzed with fractional anisotropy (FA) of the diffusion tensor imaging (DTI) tractography. Language functions were evaluated pre- and postoperatively by using the Western Aphasia Battery (WAB). The preoperative value of the FA of the arcuate fasciculus on the lesion side was examined in relation with the language recovery. Results There was a positive relationship between preoperative increasing values of the FA of the left arcuate fasciculus and improvement of the postoperative total WAB score ( p =0.0056), and the scores of the naming ( p =0.018), reading ( p =0.029), and writing subcategories ( p =0.012) Conclusion The preoperative increasing value of the FA of the arcuate fasciculus in the dominant hemisphere could be a predictor for postoperative language recovery following tumor resection. Meticulous procedure should be performed especially in the cases with higher FA of the arcuate fasciculus harboring high possibility of language recovery.

Non-fluent aphasia implies a relatively straightforward neurological condition characterized by limited speech output. However, it is an umbrella term for different underlying impairments affecting speech production. Several studies have sought the critical lesion location that gives rise to non-fluent aphasia. The results have been mixed but typically implicate anterior cortical regions such as Broca's area, the left anterior insula, and deep white matter regions. To provide a clearer picture of cortical damage in non-fluent aphasia, the current study examined brain damage that negatively influences speech fluency in patients with aphasia. It controlled for some basic speech and language comprehension factors in order to better isolate the contribution of different mechanisms to fluency, or its lack. Cortical damage was related to overall speech fluency, as estimated by clinical judgements using the Western Aphasia Battery speech fluency scale, diadochokinetic rate, rudimentary auditory language comprehension, and executive functioning (scores on a matrix reasoning test) in 64 patients with chronic left hemisphere stroke. A region of interest analysis that included brain regions typically implicated in speech and language processing revealed that non-fluency in aphasia is primarily predicted by damage to the anterior segment of the left arcuate fasciculus. An improved prediction model also included the left uncinate fasciculus, a white matter tract connecting the middle and anterior temporal lobe with frontal lobe regions, including the pars triangularis. Models that controlled for diadochokinetic rate, picture-word recognition, or executive functioning also revealed a strong relationship between anterior segment involvement and speech fluency. Whole brain analyses corroborated the findings from the region of interest analyses. An additional exploratory analysis revealed that involvement of the uncinate fasciculus adjudicated between Broca's and global aphasia, the two most common kinds of non-fluent aphasia. In summary, the current results suggest that the anterior segment of the left arcuate fasciculus, a white matter tract that lies deep to posterior portions of Broca's area and the sensory-motor cortex, is a robust predictor of impaired speech fluency in aphasic patients, even when motor speech, lexical processing, and executive functioning are included as co-factors. Simply put, damage to those regions results in non-fluent aphasic speech; when they are undamaged, fluent aphasias result.

Background and purpose A subset of patients with Alzheimer's disease (AD) present with early and prominent language deficits. It is unclear whether the burden of underlying β-amyloid pathology is associated with language or general cognitive impairment in these subjects. Methods The relationship between cortical β-amyloid burden on [11C]Pittsburgh compound B (PiB) positron emission tomography (PET) and performance on the Montreal Cognitive Assessment (MoCA), the Wechsler Memory Scale − Third Edition (WMS-III), the Boston Naming Test (BNT) and the Western Aphasia Battery (WAB) was assessed using regression and correlation analyses in subjects presenting with aphasia who showed β-amyloid deposition on PiB PET. Results The global PiB ratio was inversely correlated with MoCA (P = 0.02) and the WMS-III Visual Reproduction (VR) subtest (VR I, P = 0.02; VR II, P = 0.04). However, the correlations between PiB ratio, BNT (P = 0.13), WAB aphasia quotient (P = 0.11) and WAB repetition scores (P = 0.34) were not significant. Conclusion This study demonstrates that an increased cortical β-amyloid burden is associated with cognitive impairment, but not language deficits, in AD subjects presenting with aphasia. The results suggest that β-amyloid deposition could be partly contributing to impaired cognition in such patients whilst language dysfunction may be more influenced by other pathological mechanisms, perhaps downstream pathways of β-amyloid deposition.

The NAB is a comprehensive battery assessing five cognitive domains (Attention, Language, Memory, Spatial, Executive Function). Despite the advantage of co-normative domain data, its clinical utility is not well established because few studies have reported full-battery findings. The aim of this study was to determine if the NAB was sensitive to well documented hemispheric differences in language and spatial skills after unilateral stroke. We compared demographically matched control participants (n = 52) and individuals after left (LHD, n = 36) or right (RHD, n = 33) hemisphere damage due to stroke on the NAB, parts of the Western Aphasia Battery, and traditional visuospatial tasks. Both stroke groups showed impaired NAB Attention, Spatial, and Executive Functions relative to controls, while the LHD group was more impaired than control and RHD groups on Language and Memory modules. LHD patients with aphasia on traditional measures performed worse than control and non-aphasic LHD patients on all NAB domains. RHD patients with spatial impairment on traditional measures performed worse than controls, but not RHD patients without spatial impairment, on the NAB Spatial domain. Findings suggest the NAB is generally comparable to traditional language and visuospatial measures, and it sufficiently detects attention and executive deficits.

A 55-year-old patient was admitted with weakness in the right extremities and with significant language deficits. Both computed tomography (CT) and positron-emission tomography (PET) using 2-fluoro-2-deoxy-D-glucose were done within 1 month and repeated at 10 months after onset. Language evaluation was done using parts of the Western Aphasia Battery (WAB) and the Boston Diagnostic Aphasia Examination (BDAE) at 1 month after admission, at 3 months, and at 10 months. The initial CT scan revealed hemorrhage in the left thalamus with edema surrounding the hemorrhage. A follow-up CT scan after 10 months showed an old hemorrhage in the left thalamus with no new lesions. The initial PET scan revealed hypometabolism in the left thalamus, and a repeat PET scan at 10 months showed reduced uptake in the left frontal, left parietal, and left temporal cortex. An initial language evaluation showed impaired auditory and reading comprehension, poor verbal expression, impaired repetition, and difficulty with naming and with sentence completion. The patient was diagnosed with global aphasia. Follow-up language evaluation at 3 months and 10 months showed only minimal improvement in his communication. Global aphasia due to lesions in the thalamic region is rare and the prognosis is poor.

This article focuses on some of the long-standing problems that exist in the classification of the vascular dementias. To clarify the definition of vascular dementia, mental status and other cognitive processes were investigated in 12 patients with a single cerebral infarct (mean age, 74.8 years), 17 patients with multiple cerebral infarcts (mean age, 71.4 years), 21 vascular patients with no cerebral infarcts (mean age, 76.9 years), and 16 demographically equivalent normal elderly persons (mean age, 70.4 years). The following null hypotheses/hypotheses were tested: (a) The cognitive impairment of single-infarct, multiple-infarct, and noninfarct vascular patients is not/is significantly greater than and outside the range of that in normal aging, and (b) there are/are not significant differences between single-infarct, multiple-infarct, and noninfarct vascular patients on mental status and other cognitive measures. Measures used included the Mini-Mental State Examination, Dementia Rating Scale, Western Aphasia Battery, and Boston Naming Test. Results indicate that vascular disorders involve a decrement in mental status and other cognitive functions that is significantly greater than the age-associated cognitive impairment of normal aging. Also, results from the study indicate that there were no robust, reliable significant differences between single-infarct, multiple-infarct, and noninfarct patients. The validity of the distinction of focal versus generalized or diffuse cerebral lesions is questioned. The nosologic entity of noninfarct vascular dementia is introduced. The future nosology of vascular dementia should provide for noninfarct vascular dementia, defined as vascular dementia caused by underlying vascular mechanisms other than cerebral infarction.

Twenty-four medicated schizophrenic subjects participated in a study aimed at assessing language dysfunction in schizophrenia. Two groups of subjects participated: schizophrenic responders and non-responders to treatment with antipsychotic medication. All subjects were tested on The Western Aphasia Battery test (WAB), the Cookie Theft picture descriptions task, and the Wechsler Adult Intelligence Scales — Revised (WAIS-R) block design and picture arrangement subtests. All verbal and non-verbal assessments were compared between groups. The three main findings of this study were: 1. Severe language dysfunction among schizophrenic patients who do not respond to medication treatment. That is, therapeutic response to medication was the major predictor of the severity of language dysfunction in schizophrenia. 2. A group profile of language dysfunction differed in severity but not in shape between responders and non-responders to treatment with antipsychotic medication. 3. Schizophrenic responders and non-responders to medication treatment did not differ in their performance on a standardised picture description task and failed to reach low-moderate aphasia level. Secondary findings suggest that non-verbal aspects, such as attention and logical sequencing, may be influenced by treatment. This study represents an assessment of schizophrenic language function in relation to known language deficits of neurological patients, lending further support for the role of central nervous system (CNS) dysfunction in schizophrenia, and the importance of assessing language dysfunction as a sensitive gauge to treatment response. Vingt-quatre schizophrenes sous medication ont participe a une etude destinee a measurer les dysfonctions du langage dans la schizophrenic. L'on apris deux groupes: des schizophrenes qui reagissaient favorablement aux medicaments, et d'autres sur qui les medicaments n'avaient aucun effet. Tous ont ete testes grâce a la Western Aphasia Battery, aux epreuves de descriptions d'images du ‘Cookie Theft’, et aux sous-tests du WAIS-R Block Design and Picture Arrangement. Les groupes ont ete compares pour les notes obtenues en ce qui concemait d'une part le langage, et d'autre part les elements extra-linguistiques. Les trois principales conclusions de cette etude sont que: 1. Des desordres severes du langage apparaissent chez les schizophrenes refractaires a la medication. C'est a dire que la reaction therapeutique aux medicaments est l'indice predeterminant principal de la severite des troubles du langage dans la Schizophrenie. 2. Chez tel ou tel type collectif de trouble du langage, la difference en severite (le type restant la meme) correspond au fait que les patients reagissent on non aux traitements antipsychotiques. 3. La reaction ou l'absence de reaction aux medicaments ne cree aucune difference en cen qui concerne la performance lors d'une epreuve standardisee de description d'images, et dans ce cas tous les patients sont restees en-dessous du niveau atteint par des aphasiques de niveau inferieur-modere. Les resultants d'ordre secondaire laissent a penser que des aspects extra-linguistiques comme l'attention et le deroulement logique des idees peuvent etre influences par le traitement. Cette etude represente une evaluation de la fonction du langage chez les schizophrenes par rapport a des deficits connus du langage chez les patients neurologiques, ce qui confirme le role de la dysfonction du Systeme nerveux central dans la Schizophrenie, ainsi que l'importance de l'evaluation de la dysfonction du langage comme garantie de precision de la reaction au traitement. Vierungzwanzig schizophrene Personen in medicament Uoser Behandlung nahmen an einer Untersuchung tiel, deren Ziel die Bewertung sprachlicher Dysfunktion bei Schizophrenie war. Es nahmen zwei Gruppen teil: Schizophrene Reaktande und Nicht-Reaktande bei antipsychotischer medikamentoser Behandlung. Alle Personen wurden mit der ‘Western Aphasia Battery’, der ‘Cookie Theft’ (Keksdiebstahl) Bildbeschreibungsaufgabe und den WAIS-R Teilaufgaben ‘Block Design’ (Formentwurf) und ‘Picture Arrangement’ (Bildzusammenstellung) getestet. Beide Gruppen wurden in allen sprachlichen und nicht-sprachlichen Bewertungen miteinander verglichen. Die drei Hauptergebnisse der Studie waren: 1. Starke sprachliche Dysfunktionen wurden unter schizophrenen Patienten gefunden die auf Medikation nicht reagieren. D. H., die therapeutische Reaktion auf Medikation war der Hauptpradiktor fur die Starke der sprachlichen Dysfunktion, 2. Das Gruppenprofil der sprachlichen Dysfunktion war fur Reaktande und Nicht-Reacktande in seiner Starke jedoch nicht in seiner Form unterschiedlich, 3. schizophrene Reaktande und Nicht-Reaktande waren bei einer standardisierten Bildbeschreibungsaufgabe in ihren Leistungen vergleichbar, die oberhalb des Niveaus einer leicht-bis-mit-tleren Aphasie lagen. Weitere Ergebnisse weisen darauf hin, das nicht-sprachliche Faktoren wie Aufmerksamkeit und logische Folgerung durch eine Beehandlung beeinflusbar sein konnten. Diese Studie stellt eine Bewertung der schizophrenen Sprachfunktion inRelation zu bekannten Sprachdefiziten neuroligischer Patienten dar. Damit unterstutzt sie die Annahme einer Rolle zentraler Dysfunktion in der Schiziphrenie und unterstreicht die Wichtigkeit der Bewertung sprachlicher Dysfunktion als Masstab eines Behandlungserfolges.

Progressive apraxia of speech (AOS) can result from neurodegenerative disease and can occur in isolation or in the presence of agrammatic aphasia. We aimed to determine the neuroanatomical and metabolic correlates of progressive AOS and aphasia. Thirty-six prospectively recruited subjects with progressive AOS or agrammatic aphasia, or both, underwent the Western Aphasia Battery (WAB) and Token Test to assess aphasia, an AOS rating scale (ASRS), 3T MRI and 18-F fluorodeoxyglucose (FDG) PET. Correlations between clinical measures and imaging were assessed. The only region that correlated to ASRS was left superior premotor volume. In contrast, WAB and Token Test correlated with hypometabolism and volume of a network of left hemisphere regions, including pars triangularis, pars opercularis, pars orbitalis, middle frontal gyrus, superior temporal gyrus, precentral gyrus and inferior parietal lobe. Progressive agrammatic aphasia and AOS have non-overlapping regional correlations, suggesting that these are dissociable clinical features that have different neuroanatomical underpinnings.

There are few studies examining praxis in subjects with primary progressive aphasia. The aim of this study was to examine the pattern and severity of ideomotor apraxia in subjects with logopenic and agrammatic variants of primary progressive aphasia and to determine if the presence of ideomotor apraxia correlated with specific neuroanatomical structural abnormalities. Subjects with primary progressive aphasia were prospectively recruited and classified according to published criteria. Using the apraxia subtest of the Western Aphasia Battery, pattern and severity of ideomotor apraxia was examined in all subjects diagnosed with agrammatic and logopenic variants of primary progressive aphasia. The study included 47 subjects, 21 diagnosed with agrammatic variant of primary progressive aphasia and 26 with logopenic variant primary progressive aphasia. Subjects with agrammatic aphasia were older at onset than the logopenic variant (67.2 vs. 61.7 years, p = 0.02), but there was no difference in illness duration prior to evaluation. Those with logopenic aphasia showed more cognitive impairment on the Mini-Mental Status Examination (agrammatic = 26.7/30, logopenic = 22/30, p = 0.002), and a trend for more severe language impairment as measured by the Western Aphasia Battery-Aphasia Quotient (agrammatic = 82.3, logopenic = 75.2, p = 0.11). Strong correlations were found between Western Aphasia Battery-Aphasia Quotient and total apraxia, instrumental apraxia, and complex apraxia, while average to modest correlations were seen with upper limb apraxia and facial apraxia. After adjusting for age, mental status performance, and Western Aphasia Battery-Aphasia Quotient score, those with agrammatic aphasia had a higher degree of total apraxia (p = 0.004), facial apraxia (p = 0.03), instrumental apraxia (p = 0.0006), and complex apraxia (p = 0.0006) than those with logopenic aphasia. The agrammatic variant of primary progressive aphasia was associated with greater praxis deficits but less cognitive impairment than the logopenic variant. The presence of ideomotor apraxia was associated with grey matter loss in the left lateral premotor cortex with extension into the motor cortex. These findings suggest that although some affected areas in the agrammatic and logopenic variants of primary progressive aphasia overlap, there exists an area that is more affected in the agrammatic variant than the logopenic variant that accounts for the greater association of agrammatic aphasia with ideomotor apraxia.

There is, at present, no formal standardised assessment for closed head injury (CHI), and a general feeling of dissatisfaction by speech and language therapists with the current use of assessments available has been reported over recent years in the literature. Assessments used in CHI have traditionally been those used in the assessment of aphasia, as the language of CHI was thought to be ‘sub-clinical’ aphasia. However, it is now widely acknowledged that the diffuse neuronal damage caused by a CHI results in cognitive deficits which lead to disorders of learning, memory, perception, complex information processing and communication. It is now suggested, as a result, that the communication problems of CHI may be more similar to those associated with dementia rather than cerebrovascular disease, and that comparisons should be drawn with dementia, rather than aphasia. It is hypothesised that the Arizona Battery for Communication Disorders of Dementia (ABCD) (Bayles & Tomoeda, 1993) is an appropriate assessment tool for the language of CHI. Eight young British adults undergoing rehabilitation for a CHI in a neurological rehabilitation unit were assessed on the ABCD and also the Western Aphasia Battery (WAB) (Kertesz, 1982). Five of the subjects were able to be re-tested on both assessments approximately three months later. The hypothesis was supported by significant statistics showing that although the subjects suffered initial problems with linguistic comprehension and expression, the greater and more permanent deficits were of attention and concentration, memory, orientation, perception, judgement and self-awareness. It is suggested that the ABCD is a useful assessment for the CHI population.

Background To investigate the influence of galantamine on linguistic function, any associated factors in patients with chronic post-stroke aphasia were analysed. Methods 45 patients younger than 75 years with chronic aphasia (≥1 year since onset) were prospectively enrolled in the study. Language testing was performed at weeks 0 and 16. Initial galantamine dose was 8 mg/day for 4 weeks, and 16 mg/day for the following 12 weeks. Efficacy was evaluated by the sum of four domains (spontaneous speech, comprehension, repetition and naming) on the aphasia quotient (AQ) of the Western Aphasia Battery from baseline (AQ1) to endpoint (AQ2). Patients were considered as ‘responding’ if the increase in AQ was ≥20. Results Mean age was 60.4 years (22–74) and 14 patients were female. Mean duration of aphasia was 2.2±1.5 years. There was a significant increase in the total AQ score in the galantamine group (n=23, 48.5–57.0 percentile; p=0.007) but not in the control group (n=22, 54.3–54.9 percentile; p=0.308). The AQ2 score was independently associated with AQ1, galantamine administration and Mini-Mental State Examination (MMSE) score in multiple linear regression models. With the galantamine group, the good responders (vs poor responders) had a higher level of education (p=0.048), higher baseline MMSE score (p=0.009) and a subcortical dominant pattern (p=0.030). After adjusting for potential variables, subcortical dominant lesion was the independent determinant for galantamine responsiveness (OR 30.3; 95% CI 1.1 to 805.9, p=0.041). Conclusion Administration of galantamine had a beneficial effect on chronic post-stroke aphasia, and was more prominent in subcortical dominant lesions.

Controversy surrounds differences between cortical and subcortical aphasias and their underlying pathophysiological mechanisms, but the necessary direct comparisons between clinical characteristics of patients with the two lesion types are lacking. We compared 36 stroke patients with subcortical lesions to 42 with cortical lesions of similar volume to determine the frequency, severity, and types of aphasia found in each group, and to examine subcortical clinicoanatomical correlations. Tested on the Western Aphasia Battery (WAB), the two groups did not significantly differ either in overall aphasia severity or on any WAB subtest scores. Although some individuals had relative preservation of repetition, we did not confirm an overall difference between patients with cortical and subcortical lesions in their ability to repeat. All subcortical patients were classifiable using the WAB and a broad spectrum of aphasia types was seen. Lesion volume did not significantly correlate with aphasia severity but...